Fluorouracil belongs to a group of medicines known as antimetabolites which inhibit the growth of cells (cytostatic agent). Salicylic acid is a hard skin softening substance.

Actikerall is a solution to treat actinic keratosis (grade I/II) in adult patients with a healthy immune system.

Actinic keratoses are small crusty, scaly or crumbly patches of skin. They may be red or light brown or have the same colour as your skin. They might be dry or rough to touch and they are sometimes easier to feel than see.

These skin changes commonly occur in people that have had a lot of sun exposure.

2. What you need to know before you use Actikerall Do not use Actikerall

- if you are allergic to fluorouracil, salicylic acid or any of the other ingredients of this medicine (listed in section 6).

- while breast-feeding.

- during pregnancy, and if there is a possibility that you might be pregnant.

- if you have kidney problems.

- if it could come into contact with the eyes, the inside of the mouth or nose or the genitals (mucous membranes).

Certain other medicines can intensify the side effects of Actikerall or lead to other side effects. See 'Using other medicines' below.

Warnings and precautions

Talk to your doctor or pharmacist before using Actikerall.

- if you have reduced levels or reduced activity of an enzyme in your body called dihydropyrimidine dehydrogenase (DPD). This enzyme plays an important role in the breakdown of an active ingredient of this medicine (fluorouracil) and as a result this active ingredient might accumulate in your body. It may be necessary to have your DPD levels checked before starting treatment with Actikerall.

- if you suffer from a reduced ability to sense touch, pain and temperature (if you have diabetes, for example). In this case, your treatment areas must be closely monitored by your doctor.

- The area treated should be protected against direct sunlight as much as possible while using Actikerall and the patient must not use a sunlamp or sun bed.

- Actikerall should not be used on bleeding lesions.

- There is no experience with Actikerall for the treatment of skin cancers such as rodent ulcer (BCC) and Bowen's disease, which should therefore not be treated with the product.

- In treating an area with actinic keratosis that is also affected by another skin disease it should be taken into account that the outcome of treatment may differ.

- There is currently no data available on Actikerall treatment of other body areas apart from the face, forehead and bald scalp.

Children and adolescents

Actikerall should not be used in children or adolescents under 18 years of age. Children usually do not get actinic keratosis.

Other medicines and Actikerall

Tell your doctor or pharmacist if you are taking or have recently taken or might take any other medicines. If several medicines are taken at the same time, the effect of individual medicines can be intensified or weakened.

In particular tell your doctor if you take any of the following:

- medicines used to treat viruses such as chicken pox or shingles (brivudine, sorivudine or similar medicines). You must not use Actikerall if you are using or have used any of these medicines in the past 4 weeks as it may result in increased side effects.

- epilepsy medicine (phenytoin). Using Actikerall may lead to elevated blood levels of phenytoin. Therefore your phenytoin levels should be checked regularly.

- medicine used to treat cancer and auto-immune diseases (methotrexate). This medicine may interact with Actikerall causing undesirable effects.

- medicine used to treat diabetes (sulfonylureas). This medicine may interact with Actikerall causing undesirable effects.

Pregnancy, breast-feeding and fertility

If you are pregnant or breast-feeding, think you may be pregnant or are planning to have a baby, ask your doctor or pharmacist for advice before taking this medicine.

You must not use Actikerall while breast-feeding, during pregnancy and if there is a possibility that you might be pregnant.

Driving and using machines No special precautions are required.

Important information about some of the ingredients of Actikerall

This medicine contains dimethyl sulfoxide which may be irritant to the skin.

3. How to use Actikerall

Always use this medicine exactly as your doctor has told you. Check with your doctor or pharmacist if you are not sure.

Dosage

Actikerall should be applied once daily unless your doctor has told you otherwise.

If you have an actinic keratosis in an area of thin skin e.g. around the eyes and temple, your doctor may tell you to apply Actikerall less frequently. If severe side effects occur, reduce the frequency of drug application to three times per week until the side effects improve.

It may also be necessary for your doctor to monitor your treatment more often.

Method of administration

For application to the skin (cutaneous use).

- Remove the white film on your skin from the previous day's application by simply peeling it off (unless this is the first time you have used this medicine). Warm water may help to remove the film.

- To open the bottle, press the lid down and turn.

- Remove excess solution from the brush by wiping it on the neck of the bottle.

- Dab the solution on the actinic keratosis and a small area of healthy skin surrounding it once daily. This rim of healthy skin should be no more than 0.5 cm wide.

- Multiple actinic keratoses (up to 10 lesions) can be treated simultaneously, but do not use on large areas of skin. The total area of skin being treated with Actikerall at any one time should not exceed 25 cm2 (5 cm x 5 cm).

- Let the solution dry and form a film.

Section 3 continued overleaf

- Do not cover with a dressing.

- Close the bottle tightly to prevent it drying out. If Actikerall dries out, it must not be used any longer. Do not use Actikerall if you notice any crystals.

Further instructions

Actikerall must not be allowed to come into contact with the eyes, the inside of the mouth or nose or the genitals (mucous membranes).

Actikerall is applied to actinic keratoses once daily until the lesions have completely cleared or for up to a maximum of 12 weeks. Improvement of actinic keratoses can be seen as early as 6 weeks after starting treatment and the improvement increases over time up to 12 weeks. The clearance of actinic keratoses may continue for up to 8 weeks after stopping treatment. If you have the impression that the effect of Actikerall is too strong or too weak, talk to your doctor or pharmacist.

If you use more Actikerall than you should

If you apply Actikerall more often than once daily you will be more likely to experience skin reactions and they may be more severe. In this case, please contact your doctor.

If you forget to use Actikerall

Do not use a double dose to make up for a forgotten dose. Continue the treatment as your doctor has told you or as described in this leaflet.

If you stop using Actikerall

Please contact your doctor, if you want to stop treatment.

If you have any further questions on the use of this medicine, ask your doctor or pharmacist.

4. Possible side effects

Like all medicines, Actikerall can cause side effects, although not everybody gets them.

Mild to moderate irritation and inflammation at the site of application occur in the majority of patients treated with Actikerall. If these reactions get severe, please contact your treating doctor.

As this medicine has a very strong softening effect on the skin, whitish discolorations and scaling of the skin may occur.

The salicylic acid in Actikerall may cause slight irritation, such as skin inflammation (dermatitis) and contact allergic reactions, in patients with sensitive skin or allergy to salicylic acid. Symptoms of contact allergic reactions may include itching, reddening and small blisters even outside the area of application.

If you get any side effects, talk to your doctor or pharmacist. This includes any possible side effects not listed in this leaflet. You can also report side effects directly via the Yellow Card Scheme, Website: www.mhra.gov.uk/yellowcard.

By reporting side effects you can help provide more information on the safety of this medicine.

5. How to store Actikerall

Keep this medicine out of the sight and reach of children.

Do not use Actikerall after the expiry date which is stated on the label and on the carton after EXP The expiry date refers to the last day of that month.

Do not store above 25 °C. Do not refrigerate or freeze.

Do not use Actikerall 3 months after first opening of the bottle.

Do not use Actikerall if you notice crystals. Keep the bottle tightly closed.

Caution flammable: keep away from fire or flames.

Do not throw away any medicines via wastewater or household waste. Ask your pharmacist how to throw away medicines you no longer use. These measures will help to protect the environment.

6. Contents of the pack and other information What Actikerall contains

This medicinal product is packed in a brown glass bottle with a child resistant closure of white polypropylene in a cardboard carton. The closure of the bottle is connected to a brush to apply the solution. The brush applicator (CE mark) consists of plastic (polyethylene) with brush hairs of nylon secured in shaft with stainless steel (V2A).

Bottle containing 25 ml.

Marketing Authorisation Holder and Manufacturer

Almirall Hermal GmbH ScholtzstraSe 3 21465 Reinbek Germany

This medicinal product is authorised in the Member States of the EEA under the following names: